Provider Demographics
NPI:1093415390
Name:MERCADO ROMAN PSYCHOLOGY GROUP PSC
Entity Type:Organization
Organization Name:MERCADO ROMAN PSYCHOLOGY GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAILENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROMAN TEJERA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-644-0743
Mailing Address - Street 1:162 CALLE HELIO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-8866
Mailing Address - Country:US
Mailing Address - Phone:787-644-0743
Mailing Address - Fax:
Practice Address - Street 1:CARR 119 KM 5.5 INTERIOR, BO. PUENTE
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0062
Practice Address - Country:US
Practice Address - Phone:787-644-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty